On World Hepatitis Day, 28 July, WHO welcomes new progress in tackling one of the world’s most serious diseases. Viral hepatitis a group of infectious diseases known as hepatitis A, B, C, D, and E affects millions of people worldwide, causing acute and chronic liver disease and killing close to 1.4 million people every year.
“For years, viral hepatitis has been largely neglected,” says Dr Margaret Chan, Director-General at WHO. “But now we are beginning to see greater awareness and global momentum building to tackle it.”
This increasing interest stimulated debate on hepatitis at the 2014 World Health Assembly, when 194 countries endorsed a resolution to intensify efforts to prevent, diagnose, and treat viral hepatitis. The resolution emphasises how important it is for countries to have comprehensive national plans to tackle hepatitis designed to meet the needs of the country, using the resources available.
The World Health Assembly, composed of health ministers and other representatives from all WHO Member States, noted that testing is key: today, most people with hepatitis do not know they are infected, as often symptoms only appear decades later after serious liver disease sets in. It also highlighted the need to invest in effective prevention strategies. These include comprehensive programmes for people who inject drugs, assuring access to safe injections and blood transfusions, and expanding immunisation programmes to protect people from hepatitis A and B.
The resolution recognises the great potential of new medicines and treatment approaches for chronic hepatitis C and hepatitis B infection, calling for strategies to increase access to affordable, quality hepatitis medicines. It calls on WHO to examine the feasibility of eliminating hepatitis B and C.
World Hepatitis Day this year coincides with the 20th International AIDS Conference in Melbourne, Australia, where a wide range of sessions focus on the public health and clinical challenges of preventing and managing viral hepatitis and HIV co-infection.
Many people who are at increased risk of, and affected by, HIV are also particularly vulnerable to viral hepatitis. As many as 4-5 million people are estimated to be infected with both HIV and hepatitis B. Similar numbers are infected with both HIV and hepatitis C. As more people living with both HIV and hepatitis receive HIV treatment, they survive long enough to develop hepatitis-C related cirrhosis and liver cancer, highlighting the need to protect them better from hepatitis and to treat them if they do develop it.
“The experience gained by HIV programmes in scaling up comprehensive prevention and treatment programmes, improving access to affordable medicines and diagnostics, engaging communities and reaching vulnerable and marginalised populations can do much to inform viral hepatitis responses, addressing wider populations of people affected by hepatitis B and C,” says Dr Hiroki Nakatani, Assistant Director-General for HIV, Tuberculosis, Malaria and Neglected Tropical Diseases, WHO.
One of the most significant public health developments over the past year has been the huge advances in the treatment of chronic hepatitis C. New drugs, with others in the pipeline, have the potential to transform hepatitis C treatment, with safe and simple treatments resulting in cure rates of over 90 per cent But major challenges remain to make such treatment affordable and accessible to those populations in greatest need.
WHO has been intensifying its support to countries to expand comprehensive hepatitis prevention and treatment programmes. In April this year WHO released new guidelines for the screening, care and treatment of people with hepatitis C infection. WHO is now developing new guidelines for the prevention and management of hepatitis B. In addition, on the occasion of World Hepatitis Day, WHO is releasing a new manual for tackling outbreaks of hepatitis E.
WHO is now working with a broad range of stakeholders, including affected populations, community networks, clinicians, national hepatitis programmes, service providers and donors to implement these guidelines, to expand prevention efforts and to make treatment affordable and accessible to those in need. Already plans are being developed in a number of low- and middle-income countries to rapidly expand access to both hepatitis B and C treatment, while also ensuring that there is adequate investment in proven hepatitis prevention interventions, including hepatitis vaccination programmes, harm reduction for drug users and blood and injection safety.
“Increasing access to curative treatment for hepatitis B and C and expanding hepatitis B vaccination, and other prevention strategies, provide real opportunities for us to save lives and prevent suffering,” says Dr Gottfried Hirnschall, Director, HIV Department, WHO. “We are urging ministries of health to ‘think again’ about hepatitis and develop policies that translate into prevention and life-saving treatments.”